Collaborative quality improvement for neonatal intensive care
Collaborative quality improvement for neonatal intensive care
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DOI：
10.1542/peds.107.1.14
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发表时间：
2001-01-01
期刊：
影响因子：
8
通讯作者：
Carpenter, JH
中科院分区：
文献类型：
--
作者：
Horbar, JD;Rogowski, J;Carpenter, JH
Objective.使用多学科协作质量改进模型对新生儿重症监护的质量和成本进行可衡量的改进。干预性研究。使用Vermont Oxford网络数据库收集1994年1月1日至1997年12月31日出生体重501至1500 g婴儿的患者人口统计学和临床信息。10个自我选择的新生儿重症监护病房（NICU）接受了干预。他们组成了2个亚组（6个NICU负责感染，4个NICU负责慢性肺病）。66名其他NICU患者作为同期对照组。1994年至1997年期间，6个研究NICU感染组中出生时或出生后28天内入院的出生体重501 - 1500 g的婴儿（n = 3063）和66个比较NICU（n = 21 509）;慢性肺病组中4个研究NICU中出生体重501至1000 g的婴儿（n = 738）。NICU组成了多学科小组，从1995年1月开始，在一名训练有素的主持人的指导下，在3年期间内共同工作。他们接受了质量改进的指导，审查了性能数据，确定了共同的改进目标，并实施了“潜在的更好的做法”，通过对护理过程的分析，文献综述和现场访问。出生体重501 ~ 1500 g的婴儿出生后第3天凝固酶阴性葡萄球菌或其他细菌病原体的感染率，出生体重501 ~ 1000 g的婴儿在36周校正胎龄时的补氧率或死亡率。1994 ~ 1996年间，感染组6个NICU中凝血酶阴性肺炎的感染率从22.0%下降到16.6%;慢性肺病组4个NICU中36周校正胎龄时的辅助供氧率从43.5%下降到31.5%。在两个项目组中，NICU之间的效果存在异质性。从1994年到1997年的4年期间，在项目NICU观察到的这些结果的变化明显大于在66个对照NICU观察到的变化。我们的结论是，多学科协作质量改进有可能改善新生儿重症监护的结果。
Objective. To make measurable improvements in the quality and cost of neonatal intensive care using a multidisciplinary collaborative quality improvement model.Design. Interventional study. Patient demographic and clinical information for infants with birth weight 501 to 1500 g was collected using the Vermont Oxford Network Database for January 1, 1994 to December 31, 1997.Setting. Ten self-selected neonatal intensive care units (NICUs) received the intervention. They formed 2 subgroups (6 NICUs working on infection, 4 NICUs working on chronic lung disease). Sixty-six other NICUs served as a contemporaneous comparison group.Patients. Infants with birth weight 501 to 1500 g born at or admitted within 28 days of birth between 1994 and 1997 to the 6 study NICUs in the infection group (n = 3063) and the 66 comparison NICUs (n = 21 509); infants with birth weight 501 to 1000 g at the 4 study NICUs in the chronic lung disease group (n = 738).Interventions. NICUs formed multidisciplinary teams that worked together under the direction of a trained facilitator over a 3-year period beginning in January 1995. They received instruction in quality improvement, reviewed performance data, identified common improvement goals, and implemented "potentially better practices" developed through analysis of the processes of care, literature review, and site visits.Main Outcome Measures. The rates of infection after the third day of life with coagulase-negative staphylococcal or other bacterial pathogens for infants with birth weight 501 to 1500 g, and the rates of oxygen supplementation or death at 36 weeks' adjusted gestational age for infants with birth weight 501 to 1000 g.Results. Between 1994 and 1996, the rate of infection with coagulase-negative staphylococcus decreased from 22.0% to 16.6% at the 6 project NICUs in the infection group; the rate of supplemental oxygen at 36 weeks' adjusted gestational age decreased from 43.5% to 31.5% at the 4 NICUs in the chronic lung disease group. There was heterogeneity in the effects among the NICUs in both project groups. The changes observed at the project NICUs for these outcomes were significantly larger than those observed at the 66 comparison NICUs over the 4-year period from 1994 to 1997.Conclusion. We conclude that multidisciplinary collaborative quality improvement has the potential to improve the outcomes of neonatal intensive care.